Effect of L-carnitine administration on erythropoietin use in thalassemic minor haemodialysis patients.

Effect of L-carnitine administration on erythropoietin use in thalassemic minor haemodialysis patients Sir, We read with great interest the recent letter by Arduini et al. [1], on the effect of L-carnitine (LC) on erythrocyte survival in haemodialysis patients. In the same issue, there is a paper by Hothi et al. [2] showing that plasma free-carnitine (FC) levels fell from 26. They conclude that NHD is associated with an improvement in AC : FC ratio. Anaemia is a common finding in patients on chronic haemodialysis (HD), and represents one of the leading causes of increased cardiovascular morbidity and mortality in these patients. While the main defect responsible for anaemia in chronic renal failure patients is inadequate production of erythropoietin, there is evidence that other factors may also be involved. Several studies have shown that LC supplementation may have a beneficial effect on renal anaemia [3]. Arduini et al. [1] report the first randomized controlled trial of the effects of LC on erythrocyte survival in HD patients. Red blood cells (RBC) survival was evaluated by the 51Cr labelling procedure, a gold standard methodology in RBC survival studies [4]. There was a strong trend towards improved RBC survival in the treated group (P ¼ 0.058), and this mechanism might explain in part the reported benefit of LC supplements on anaemia control in HD patients [1]. Several authors suggest various fundamental mechanisms of carnitine deficiency that may contribute to anaemia in patients with chronic uraemia [5–8]. The biophysical properties of the erythrocyte membrane and its cytoskeletal network are fundamental for RBC survival in the blood stream [5]. Indeed, RBCs must survive a variety of chemical and physical insults during their life span, and the loss of their elastic properties may severely compromise tissue oxygenation. Erythrocyte deformability has been found to be impaired in uraemia [5] and to correlate with shortened RBC survival time [9–11]. LC treatment of HD patients seems to alleviate their anaemic condition. Recently, Duranay et al. [12] showed that there was a significant benefit of L-carnitine on C-reactive protein (CRP), transferrin, total protein and albumin levels of haemodialysis patients. LC treatment of HD patients seems to alleviate their anaemic condition. A recent meta-analysis of the randomized LC trials performed before and after the advent of erythropoietin therapy shows a beneficial effect of LC supplements on anaemia control in maintenance HD patients [1]. This conclusion is consistent with the concept that LC …